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Disclosures: The authors report no relevant financial disclosures.
June 24, 2020
2 min read

Disease severity, not myocardial infection, associated with arrhythmia, death in COVID-19

Disclosures: The authors report no relevant financial disclosures.
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Among patients admitted with COVID-19, those transferred to the ICU were more likely to experience arrhythmias, cardiac arrest and death compared with patients who did not go to the ICU, researchers reported.

Investigators concluded that non-CV causes such as age, systemic infection and inflammation were more likely to result in cardiac arrest compared with direct myocardial infection from COVID-19.

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“In order to best protect and treat patients who develop COVID-19, it’s critical for us to improve our understanding of how the disease affects various organs and pathways within our body — including our heart rhythm abnormalities,” Rajat Deo, MD, MTR, cardiac electrophysiologist and associate professor of cardiovascular medicine at Perelman School of Medicine at the University of Pennsylvania, said in a press release. “Our findings suggest that noncardiac causes such as systemic infection, inflammation and illness are likely to contribute more to the occurrence of cardiac arrest and arrhythmias than damaged or infected heart cells due to the viral infection.”

For this analysis published in HeartRhythm, investigators assessed 700 patients with COVID-19 (mean age, 50 years; 45% men; 71% Black; 11% admitted to ICU) admitted during a 9-week period to determine the risk for cardiac arrest and arrhythmias (atrial fibrillation, bradyarrhythmias and nonsustained ventricular tachycardia).

In a univariate analysis, researchers found that a 1-year increase in age was associated with incident AF (OR = 1.06; 95% CI, 1.04-1.09), bradyarrhythmia (OR = 1.03; 95% CI, 1-1.06) and nonsustained ventricular tachycardia (OR = 1.04; 95% CI, 1.01-1.08) in patients with COVID-19. But after multivariable adjustment, AF was the only arrhythmia that remained independently associated (OR = 1.05; 95% CI, 1.02-1.09).

Patients admitted to the ICU were more likely to die in-hospital compared with those initially admitted to the non-ICU ward (23% vs. 2%; P < .001).

HF and incident arrhythmias

In a separate univariate analysis, HF was also associated with incident AF (OR = 5.61; 95% CI, 2.37-13.25) and bradyarrhythmias (OR = 9.16; 95% CI, 2.41-34.79). But after multivariable adjustment, HF remained associated only with bradyarrhythmias (OR = 9.75; 95% CI, 1.95-48.65).

“Further support is also provided by our study’s non-ICU population of 621 patients, who had a much lower rate of acute mortality,” Anjali Bhatla, BA, student at the Perelman School of Medicine at the University of Pennsylvania, and colleagues wrote. “No cardiac arrests were observed in this group, which comprised nearly 90% of our COVID-19 population.”

Researchers also demonstrated that cardiac arrest was associated with in-hospital mortality (OR = 20.47; 95% CI, 5.19-80.69). The association remained, even after controlling for age, sex, race, prevalent CVD, ICU status and treatment with hydroxychloroquine (OR = 34.99; 95% CI, 3.49-350.69).


Disease severity, not direct infection

“Patients with more severe systemic illness as evidenced by ICU admission also had a greater likelihood of developing cardiac arrhythmias,” the researchers wrote. “The association with bradyarrhythmias could be explained after accounting for demographic and clinical differences such as underlying cardiovascular risk factors and disease between ICU and non-ICU patients. However, unmeasured factors that relate to the severity of illness likely explain the ongoing, independent association between ICU admission and incident AF and nonsustained ventricular tachycardia.”